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Canadian Older Adults’ Perceptions of Transitioning from Driver to Non-Driver
Abstract
Ceasing driving is associated with many negative outcomes. We examined the perceived impact of driving cessation among current older drivers. Transcripts from 92 interviews with participants from several locations across Canada were analyzed using inductive thematic analysis. We identified five themes: planning for mobility change, mobility supports and neighborhoods, financial security, fearing loss of control and independence, and coping and acceptance as a part of aging. Findings highlight diverse attitudes toward driving cessation, ranging from avoidance to acceptance, and emphasize the importance of tailored resources for drivers at various stages of behavior change.
... With the aging of the population and the continued dependence on driving as the main mode of transportation in Westernized countries, the issue of older adults ceasing driving has attracted significant research focus. In North America, driving is an important part of peoples' identity , contributes to quality of life (Dickerson et al., 2007;Musselwhite & Haddad, 2010), offers community mobility (Musselwhite & Haddad, 2010), and provides a sense of freedom and independence (Musselwhite & Haddad, 2010;Oxley & Whelan, 2008;Stinchcombe et al., 2021). As a result of declines in health and cognition, many older adults have to discontinue driving due to safety concerns (Antin et al., 2017;Maliheh et al., 2023). ...
... Shope (2003) also documented that older drivers did not want to consider driving cessation, because their vehicle was an essential element of their lives. In a recent study of 92 older drivers, this same reluctance about driving cessation was reiterated, along with the shortcomings of other mobility options (e.g., walking, public transportation alternatives; Stinchcombe et al., 2021). This reluctance about driving cessation highlights that the need for, and the many advantages of, a private automobile do not end when one stops driving. ...
Importance:
Driving cessation affects older drivers and, possibly, also care partners (most of whom tend to be women). Although tools exist to assess the effects on family and friends of providing informal care to someone who needs assistance, no tool is available to clinicians that specifically focuses on the effects of driving cessation.
Objective:
To develop the Transportation Support Scale (TSS) to measure care partners' responses-both negative and positive-to driving cessation and assuming transportation responsibilities.
Design:
We developed a list of 98 items to capture the impact on care partners of providing transportation to older adults who have stopped driving. In Phase 1, we pretested the items qualitatively with a small sample of care partners. In Phase 2, we reduced the number of items and examined several psychometric properties of the TSS with a larger sample.
Setting:
Community.
Participants:
Two convenience samples of care partners who provide transportation (Phase 1, n = 11; Phase 2, n = 66).
Results:
The initial pool of items was reduced from 98 to 22. The final TSS has an internal consistency of .88 (Cronbach's α). Thirty-five percent of care partners' scores fell above the middle possible score; these care partners were likely experiencing a high negative impact related to providing transportation after driving cessation.
Conclusions and relevance:
The TSS demonstrated adequate preliminary psychometric properties. We need additional research to further evaluate the psychometric properties of the TSS (e.g., test-retest reliability). A fully validated TSS may be useful to clinicians and researchers. What This Article Adds: The TSS has the potential to help clarify the perspective of care partners as well as inform the development and evaluation of services for care partners who are providing transportation to former drivers.
... As most North American neighbourhoods are designed for personal automobiles as the primary mode of transportation, driving remains an important activity for older adults' physical, psychological, and social needs (Turcotte, 2012). Many older adults have been driving for more than 60 years, making driving a part of their identity and relating the ability to drive to a sense of freedom and independence (Stinchcombe, Hopper, Mullen, & Bédard, 2021). Although linked to overall health and well-being, driving is also associated with risk of injury and mortality as it is a complex task that requires a combination of physical abilities, cognitive functioning, visual acuity, and processing speed to perform safely (Ang, Jennifer, Chen, & Lee, 2019). ...
As individuals age and become aware of changes in their driving capabilities, they are more likely to self-regulate their driving by avoiding certain driving situations (i.e., night driving, rush hour traffic, etc.). In this paper, we sought to examine the correlates of situational driving avoidance with a particular emphasis on the roles of personality traits, gender, and cognition within a large sample of mid-life and older adults from the Canadian Longitudinal Study on Aging (CLSA). Our findings show that women of older ages tend to report more driving avoidance and that personality traits, specifically extraversion, emotional stability, and openness to experience, may reduce driving avoidance. A negative association was also found between cognition and driving avoidance, such that individuals with higher cognition reported less driving avoidance.
Introduction:
With an aging population there are more older drivers than ever before. To reduce unnecessary road accidents and assist older drivers to successfully transition to non-driving, a better understanding of the factors that influence planning for driving retirement is required. This review explores documented factors that may influence older adults in planning for driving retirement, thus providing new understandings that can inform future preventative road safety measures, interventions, and policies.
Method:
A systematic search was performed using four databases to locate qualitative studies on the factors that influenced older drivers to plan for driving retirement. To identify factors influencing planning for driving retirement, a thematic synthesis approach was utilized. Identified themes were categorized in relation to elements of the Social Ecological Model theoretical framework.
Results:
The systematic search resulted in 12 included studies from 4 countries. Four major themes and 11 subthemes were identified regarding planning driver retirement. Each subtheme denotes a factor that may facilitate and/or impede older drivers planning for driving retirement.
Conclusion:
These results indicate that it is vitally important to encourage older drivers to plan for driving retirement as early as possible. Stakeholders involved in the safety of older drivers (including family, clinicians, road authorities, and policy makers) should work together on interventions and policies that empower older drivers to successfully plan for driving retirement in order to improve road safety and quality of life.
Practical applications:
Introducing conversations about driving retirement via medical appointments, family, media, and peer-support groups could facilitate planning for driving retirement. Community-based ride-sharing systems and subsidized private transport options are needed to ensure continued mobility of older adults, especially in rural and regional areas that lack alternate transport services. When devising urban and rural planning, transport, license renewal, and medical testing rules, policy makers should consider older drivers' safety, mobility, and quality of life after driving retirement.
Background:
Many older adults face the difficult decision of when to stop driving. We sought to test whether an online driving decision aid (DDA) would improve decision quality.
Methods:
This prospective two-arm randomized trial enrolled English-speaking licensed drivers (age ≥70 years) without significant cognitive impairment but with ≥1 diagnosis associated with increased likelihood of driving cessation; all participants received primary care in clinics associated with study sites in three states. The intervention was the online Healthwise® DDA for older adults addressing "Is it time to stop driving?"; control was web-based information for older drivers only. The primary outcome was decision conflict as estimated by the Decisional Conflict Scale (DCS; lower scores indicate higher quality). Secondary outcomes were knowledge and decision self-efficacy about driving decisions. We examined postrandomization differences in primary and secondary outcomes by study arm using generalized linear mixed-effects models with adjustment for site and prerandomization scores.
Results:
Among 301 participants (mean age: 77.1 years), 51.2% identified as female and the majority as non-Hispanic (99.0%) and white (95.3%); 98.0% lived in an urban area. Participant characteristics were similar by study arm but differed across sites. Intervention participants had a lower mean DCS score (12.3 DDA vs 15.2 control; adjusted mean ratio [AMR] 0.76, 95%CI 0.61-0.95; p = 0.017). Intervention participants had higher mean knowledge scores (88.9 DDA vs. 79.9 control; OR 1.13, 95%CI 1.01-1.27, p = 0.038); there was no difference between groups in self-efficacy scores. The DDA had high acceptability; 86.9% of those who viewed it said they would recommend it to others in similar situations.
Conclusions:
The online Healthwise® DDA decreased decision conflict and increased knowledge in this sample of English-speaking, older adults without significant cognitive impairment, although most chose to continue driving. Use of such resources in clinical or community settings may support older adults as they transition from driving to other forms of mobility.
Trial registration:
ClinicalTrials.gov identifier "Advancing Understanding of Transportation Options (AUTO)" NCT04141891.
Driving cessation, often due to health-related changes, can be a particularly challenging and troublesome transition in older adulthood that can lead to social isolation. While policy makers have long recognized the potential impact of an aging population on Canada's health care and national pension plans, the transportation needs of older adults have received relatively less attention. For older adults residing in small towns and rural areas who rely, more often than not, on the personal automobile there is usually limited or no access to public transportation. For policy makers to respond effectively to the transportation needs of an aging population, particularly those living in rural areas, the first step is to understand the travel behaviours of older adults living in such areas, particularly as they approach the transition when they will cease to drive. This paper reports on qualitative research exploring the driving-related challenges and needs faced by older adults in small towns and rural areas near Hamilton, Ontario, Canada. Results revealed four major themes: lack of transportation options in rural areas, changes in driving behaviours, the lack of planning for driving cessation, and the social isolation that comes from the loss (or potential loss) of one's driver's license.
Semistructured in-depth interviews are commonly used in qualitative research and are the most frequent qualitative data source in health services research. This method typically consists of a dialogue between researcher and participant, guided by a flexible interview protocol and supplemented by follow-up questions, probes and comments. The method allows the researcher to collect open-ended data, to explore participant thoughts, feelings and beliefs about a particular topic and to delve deeply into personal and sometimes sensitive issues. The purpose of this article was to identify and describe the essential skills to designing and conducting semistructured interviews in family medicine and primary care research settings. We reviewed the literature on semistructured interviewing to identify key skills and components for using this method in family medicine and primary care research settings. Overall, semistructured interviewing requires both a relational focus and practice in the skills of facilitation. Skills include: (1) determining the purpose and scope of the study; (2) identifying participants; (3) considering ethical issues; (4) planning logistical aspects; (5) developing the interview guide; (6) establishing trust and rapport; (7) conducting the interview; (8) memoing and reflection; (9) analysing the data; (10) demonstrating the trustworthiness of the research; and (11) presenting findings in a paper or report. Semistructured interviews provide an effective and feasible research method for family physicians to conduct in primary care research settings. Researchers using semistructured interviews for data collection should take on a relational focus and consider the skills of interviewing to ensure quality. Semistructured interviewing can be a powerful tool for family physicians, primary care providers and other health services researchers to use to understand the thoughts, beliefs and experiences of individuals. Despite the utility, semistructured interviews can be intimidating and challenging for researchers not familiar with qualitative approaches. In order to elucidate this method, we provide practical guidance for researchers, including novice researchers and those with few resources, to use semistructured interviewing as a data collection strategy. We provide recommendations for the essential steps to follow in order to best implement semistructured interviews in family medicine and primary care research settings.
Objective: This study investigated the impact of driving cessation on social isolation in older adults. Method: Data were obtained from Rounds 1 through 6 of the National Health and Aging Trends Study. The study sample consisted of 6,916 Medicare beneficiaries aged 65 or above who were eligible drivers at baseline. Mixed-effects ordered logistic regression and piecewise regression were used to examine the impact of driving cessation on social isolation. Results: In multivariable mixed-effects ordered logistic regression, past-year nondrivers had a twofold increase in the odds of being in a higher social isolation category (odds ratio [OR] = 2.1, p < .001). Piecewise regression analysis showed that social isolation scores increased by 0.08 points ( p = .024) following an incident of driving cessation. Discussion: Driving cessation is associated with a higher risk of social isolation in older adults. Interventions to reduce social isolation among older adults may improve public health by targeting older adults who have recently stopped driving.
This project aimed to identify the impact of driving cessation from the perspectives of older drivers and former drivers. Participants included 17 adults aged 65-88 years residing in a city in Northwestern Ontario, Canada. Using a semi-structured interview guide (with questions regarding mobility, personal impact, impact on others, engagement with life, and finances), two focus groups were held with nine current drivers, and one-on-one interviews were held with six former drivers and two current drivers. Two themes emerged concerning stopping driving. The first theme included discussions on experiencing lifestyle changes, relationship impacts, and emotional impacts. The second, the adjustment to stopping driving, included practical adaptations, and emotional responses such as appreciation, resistance, acceptance, and being positive. Although the impacts of stopping driving were substantial, there were few discrepancies between what was anticipated and what was experienced. This information could assist with developing interventions to ease the transition to former-driver status.
Objectives:
To determine what effect driving cessation may have on subsequent health and well-being in older adults.
Design:
Systematic review of the evidence in the research literature on the consequences of driving cessation in older adults.
Setting:
Community.
Participants:
Drivers aged 55 and older.
Measurements:
Studies pertinent to the health consequences of driving cessation were identified through a comprehensive search of bibliographic databases. Studies that presented quantitative data for drivers aged 55 and older; used a cross-sectional, cohort, or case-control design; and had a comparison group of current drivers were included in the review.
Results:
Sixteen studies met the inclusion criteria. Driving cessation was reported to be associated with declines in general health and physical, social, and cognitive function and with greater risks of admission to long-term care facilities and mortality. A meta-analysis based on pooled data from five studies examining the association between driving cessation and depression revealed that driving cessation almost doubled the risk of depressive symptoms in older adults (summary odds ratio = 1.91, 95% confidence interval = 1.61-2.27).
Conclusion:
Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. These adverse health consequences should be considered in making the decision to cease driving. Intervention programs ensuring mobility and social functions may be needed to mitigate the potential adverse effects of driving cessation on health and well-being in older adults.
Aim:
To synthesize published qualitative studies to identify older adults' preferences for communication about driving with healthcare providers.
Background:
Healthcare providers play a key role in addressing driving safety and driving retirement with older adults, but conversations about driving can be difficult. Guides exist for family members and providers, but to date less is known about the types of communication and messages older drivers want from their healthcare providers.
Design:
Qualitative metasynthesis of studies published on or before October 10, 2014, in databases (PubMed, CINAHL, PsycINFO and Web of Science) and grey literature.
Review methods:
22 published studies representing 518 older adult drivers met the following inclusion criteria: (1) the study was about driving; (2) the study involved older drivers; (3) the study was qualitative (rather than quantitative or mixed methods); and (4) the study contained information on older drivers' perspectives about communication with healthcare providers.
Results:
We identified five major themes regarding older adults' communication preferences: (1) driving discussions are emotionally charged; (2) context matters; (3) providers are trusted and viewed as authority figures; (4) communication should occur over a period of time rather than suddenly; and (5) older adults desire agency in the decision to stop driving.
Conclusion:
Various stakeholders involved in older driver safety should consider older drivers' perspectives regarding discussions about driving. Healthcare providers can respect and empower older drivers-and support their family members-through tactful communication about driving safety and mobility transitions during the life course.
Many social science studies are based on coded in-depth semistructured interview transcripts. But researchers rarely report or discuss coding reliability in this work. Nor is there much literature on the subject for this type of data. This article presents a procedure for developing coding schemes for such data. It involves standardizing the units of text on which coders work and then improving the coding scheme's discriminant capability (i.e., reducing coding errors) to an acceptable point as indicated by measures of either intercoder reliability or intercoder agreement. This approach is especially useful for situations where a single knowledgeable coder will code all the transcripts once the coding scheme has been established. This approach can also be used with other types of qualitative data and in other circumstances.
Driving cessation is a gradual process, where driver's self-regulation plays an important role. Age-based licence renewal may interfere with this process and trigger premature driving cessation. The present study compares Danish drivers (aged 69 years at the baseline) who either renewed or gave up their driving licence. Data were collected in 2009 (N=1,792) and in 2012 (N=863). The standardised interviews covered respondents' background information, health and wellbeing, and transportation patterns. Non-renewers had poorer health already at baseline but did become more dependent on others in their activities after giving up their licence. In travel frequency, neither the differences between renewers and non-renewers nor the changes over time within the groups were pronounced. The groups differed in their use of transport modes already at the baseline: the renewers drove, while non-renewers travelled as passengers, used public transport, walked or cycled. Not renewing the licence was a strong predictor of unmet mobility needs, especially in relation to leisure activities. The present study indicates that younger seniors' mobility is not likely to be affected by the strict renewal policies. However, given the positive economic and safety consequences of independent mobility in old age, society should try to prevent unwarranted mobility loss. Having restrictive, ageist policies that moreover fail as societal investments may work against this goal.
Purpose:
Many older adults consider driving vital to maintaining their preferred lifestyle and engagement with society, yet it is normative for individuals to eventually stop driving. This study examined the impact of driving cessation on older adults' productive and social engagement and whether their mental and physical health mediated this relationship.
Design and methods:
Multilevel modeling was used to analyze longitudinal data (N = 4,788 adults age 65 and over) from the Health and Retirement Study (1998-2010).
Results:
Productive engagement (paid work, formal volunteering, and informal volunteering) was negatively affected when older adults stopped driving, but social engagement was not immediately compromised by their transition to nondriver status. The role of physical health and mental health as mediators in explaining this relationship was negligible.
Implications:
The results suggest that interventions aimed at maintaining nondrivers' participation in productive roles should focus on factors other than enhancement of health and well-being to spur greater engagement (e.g., availability of and barriers to use of public transportation). Also important in the intervention process is planning for mobility transitions. Future research should test for geographic (e.g., urban vs. rural) differences in the impact of driving cessation on productive and social engagement.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
The aging process is marked by a series of transitions that influence multiple domains of well-being. One important transition for older adults is the process of driving cessation. Numerous studies have examined risk factors for driving cessation among older adults to identify at-risk older drivers for road safety. Recent research has focused on the consequences of driving cessation in later life for health and well-being. However, these reports have been largely empirical and are not drawn from a defined conceptual framework. Establishing a theoretical model of 'how driving cessation interacts with other processes and domains of aging' will promote synthesis of seemingly disparate findings and also link the empirical research on cessation to the broader field of gerontology. This article describes a conceptual model for articulating and examining the components of the driving cessation process based on the stress-coping paradigm. This model situates driving cessation within the context of exogenous stressors, individual vulnerabilities and coping strategies, and environmental hazards and buffers over the lifespan. This model could assist in guiding intervention strategies aimed at reducing premature driving cessation in older drivers with ameliorable impairments while assisting at-risk older drivers to reduce or stop driving in a less stressful way.
Most studies analyzed the impact of decreased mobility on health and social network status, but only a few have provided evidence to understand how these latter factors could affect travel decisions or outcomes. This paper examined the linkage between people’s car driving and public transit use in Canada and their personal, health and social network characteristics, with a focus on the elderly population. The study exploits Statistics Canada’s General Social Survey (GSS-19), a unique survey with a nationally representative sample that contains questions on health, social network and transportation situation. Multilevel binary logistic regression models were estimated for the two travel modes. Results showed that regardless of age, poor health discourages both car driving and public transit use. Physical limitations that constrain mobility were found to decrease the likelihood of using public transit, a finding that was expected. However, a very interesting finding of this study is that even in the presence of physical or mental situations, mobility is still made possible through car driving. Relatedly, the study showed how important license possession and car ownership are to personal mobility and to be less dependent on other modes of transport including public transit.
Findings from this study have also underlined that family network could play an important role in influencing both mobility decisions and provision. Car driving was found to be more likely when a person lives alone versus with one or more people in the household, a tendency that is stronger among the elderly than the non-elderly group. However, in the event of voluntary driving cessation, suspension of driving license, or when other means of transport would not be a convenient or feasible option, support from family members or caregivers could be critical given that, and as this study finding showed, elderly people are likely to continue to strive to maintain their driving skills even with a health condition, rather than prepare to stop driving. The size of close family networks did not show a considerable influence, but the quality of these ties (i.e. being close to family) was found relevant in public transit use. Results underlined implications to road safety, the development of alternative transport strategies and strengthening social support to help maintain mobility necessary for health and quality of life in later years.
Although decisions related to driving are vital to well-being in later life, little is known about how aging drivers who do not experience a medical condition that requires driving cessation regulate their driving. This exploratory, qualitative study used focus groups with 79 such community-dwelling individuals to examine driving self-regulation from the perspective of pre-senior (aged 55-64) drivers, senior (aged 65 years or over) drivers, and senior ex-drivers. Themes resulting from inductive analysis addressed the importance of driving, mechanisms of self-monitoring and self-regulation, people who influenced decision making, and opinions regarding licensing regulations. A preliminary model of the process of self-regulation that highlights intrapersonal, interpersonal, and environmental influences on why, how, and when aging drivers adapt or cease driving is presented. The model identifies areas for future research to enhance understanding of this process, including the effectiveness of self-regulation. Findings suggest that increased public awareness of issues related to driving and aging could assist aging drivers, their families, and their family physicians in optimizing driving safety for this population. Since a near accident or accident was seen as the only factor that would lead many informants to stop driving and few informants planned for driving cessation, there is a need for interventions that help aging drivers make the transition to ex-driver in a timely and personally acceptable way.
As a result of our aging population, the coming years will see increasing numbers of older adults faced with the prospect of giving up driving due to poor health or functional limitations. Driving cessation has been associated with negative psychosocial outcomes for older adults including restricted mobility and depression. While several studies report evaluations of interventions designed to help older adults to drive safely for longer, there is a paucity of published research concerned with the design or implementation of intervention programs intended to reduce the negative consequences of driving cessation. This paper reviews cognitive and educational interventions designed to promote older driver safety, and discusses possible approaches to the design and implementation of clinical interventions for older adults who have ceased driving. A broad framework for adaptable interventions based on the theoretical tenets of social cognitive theory, with an emphasis on planning for cessation, problem-solving and the involvement of friends and family members is proposed.
Older drivers’ self-awareness of driving ability can prompt self-regulatory behaviors and modifications of their everyday driving performance. To date, studies have yet to examine how older drivers’ self-awareness of changes in driving ability over time or identify the characteristics of those who can accurately monitor such changes. 64 older drivers (Age: Mean = 80.0 years, SD = 5.4; male: 70 %) were recruited and categorized into four groups based on the correspondence of changes in their perceived and actual driving ability over one year: 40 % of the participants were accurate in their stable or better driving ability over time, 30 % did not detect their driving performance had worsened and over-estimated their driving ability, and the remainder either accurately detected their performance had worsened or under-estimated their driving performance. No demographic or clinical factors were associated with older drivers’ self-awareness of changes in driving ability over time, except the mental processing and executive functioning measured using the Trail Making Tests Part B, showed a marginal effect. Implications for clinical importance are discussed.
This study examined the association between socio-demographic and driving characteristics and plans to cease driving in older drivers with and without suspected mild cognitive impairment (MCI), as measured by the Telephone Cognitive Screen (T-CogS) score. Lifestyle changes that participants had made to assist them transition to non-driving and their concerns about driving cessation were also examined. The study sample comprised 973 older drivers (65+ years) living in Perth, Western Australia. Information was collected on socio-demographic characteristics, health, cognitive function, driving-related characteristics and driving cessation. Descriptive and univariate statistics were undertaken to assess differences between drivers with and without suspected MCI. Multivariate logistic regression models examined the association between socio-demographic/driving-related characteristics and plans to cease driving. Increasing age (adjusted OR: 1.75, 95% CI = 1.22–2.50, p < 0.01), living alone (adjusted OR: 1.61, 95% CI = 1.09–2.38, p = 0.02), “suggestion to stop or limit driving in the past year” (adjusted OR: 5.07, 95% CI = 1.09–23.57, p = 0.04) and thinking it was “not important to continue driving” (adjusted OR: 4.80, 95% CI = 1.93–11.95, p < 0.01) were significantly associated with plans to cease driving. The odds were also doubled for drivers who reported that they were “less confident in their driving skills” than those who felt that their “driving skills were about the same” when compared to five years ago (adjusted OR: 2.29, 95% CI = 1.37–3.81, p = 0.01). Yet, only one-quarter of the drivers who planned to cease driving had made lifestyle changes as they transitioned to non-driving (26.1%, n = 134), despite most having at least one concern about driving cessation (92.2%, n = 474). Further research is needed to understand the decision-making process of older drivers as they transition to non-driving and help to develop strategies to promote their safe mobility and ease their transition when driving is no longer feasible.
Objective
This exploratory study examined the concept of psychological resilience and self-reported measures of driving comfort, abilities, and self-regulatory driving behavior in adults aged 75 years and older (Male: 69.9%; Mean age = 81.6 years, SD = 3.3, Range = 76.0–90.0). As resilience is associated with adaptive coping skills, it was anticipated that older drivers with higher resilience scores would be more likely to exhibit self-regulatory driving behavior.
Method
Participants from the Ozcandrive older driver cohort study (Melbourne, Australia) completed: a demographic questionnaire; a battery of functional/health assessments; driving comfort, perceived abilities and self-regulatory scales; and a resilience scale. Data for a subset of 183 participants were analyzed.
Results
Hierarchical regression analyses using age, sex, driving exposure, and resilience showed that adding resilience into the models resulted in statistically significant increases in the amount of variance explained, however, the resulting total R-squared values remained modest (i.e. R² between 0.074 and 0.305). After combining all variables into each model, resilience remained significant in all models except situational driving avoidance. Findings for females support the hypothesis that those with higher resilience report more self-regulatory driving behavior, with contrasting findings for males.
Discussion
The current findings add to the literature on factors influencing later-life driving decisions and provide more information for extending safe mobility for older adults. The study highlights a promising new domain of research to understand how older adults navigate the process of aging and driving and can provide stakeholders with more information to best prepare for the transportation and mobility issues that lie ahead.
Background and objectives:
Older adults can expect to live between 6 and 10 years after they give up driving, but driving reduction and cessation (DRC) are not equally experienced by all groups. Individual characteristics such as poor health, impaired vision, older age, and female gender are known to affect DRC. Using cumulative disadvantage theory as a guide, this study assessed the role played by wealth in DRC among older adults.
Research design and methods:
Data from the National Health and Aging Trends Study were analyzed using multinomial logistic regression techniques. This allowed for the effect of each predictor on the odds of engagement in a given driving status (full driving, driving reduction [DR], and driving cessation [DC]) to be compared to each of the others.
Results:
The final sample included 6,387 participants. After controlling for the effect of covariates, less wealth was associated with higher odds of DR compared to full driving, DC compared to full driving, and DC compared to DR. Confirming previous research, several other factors were also significantly related to driving status including age, health, vision, gender, race, education, relationship status, household size, and work status.
Discussion and implications:
The influence of wealth on driving status among older adults represents another disadvantage unequally distributed to some in older adulthood. Those with less wealth will have fewer resources to meet their mobility needs using alternatives and may already be facing additional financial constraints due to worse health and other challenges associated with lower socioeconomic status.
Background and objectives:
Despite the well-recognized difficulty that persons with dementia and family carers experience in the decision making and transition to nondriving, there are few interventions and resources to support them. As part of our ongoing research to develop a driving cessation toolkit that addresses this gap, we sought to examine the context-specific factors relevant to its effective implementation in settings that support older adults with dementia.
Research design and methods:
A qualitative descriptive approach was used to explore the perspectives of Alzheimer Society (AS) staff in their work of supporting people with dementia and family carers within the context of driving cessation. Individual in-depth interviews were conducted with 15 AS staff members in 4 Canadian provinces. Data were examined using interpretative thematic analysis.
Results:
The study results revealed an overarching paradox that despite the importance of driving cessation in people with dementia, it continues to be largely avoided at the individual and system levels. This is explored via the themes of (a) paradox of importance and avoidance identified in AS settings; (b) lack of awareness and understanding about dementia and driving among people with dementia and family carers; (c) distress and avoidance rooted in ongoing system issues; and (d) moving driving cessation to the "front burner."
Discussion and implications:
Viewed through the emerging social health paradigm, which focuses on the social and emotional consequences of dementia, our results highlight the urgent need to mobilize our communities, medical education systems, and transportation authorities to finally resolve the dementia and driving cessation paradox.
Since initially writing on thematic analysis in 2006, the popularity of the method we outlined has exploded, the variety of TA approaches have expanded, and, not least, our thinking has developed and shifted. In this reflexive commentary, we look back at some of the unspoken assumptions that informed how we wrote our 2006 paper. We connect some of these un-identified assumptions, and developments in the method over the years, with some conceptual mismatches and confusions we see in published TA studies. In order to facilitate better TA practice, we reflect on how our thinking has evolved – and in some cases sedimented – since the publication of our 2006 paper, and clarify and revise some of the ways we phrased or conceptualised TA, and the elements of, and processes around, a method we now prefer to call reflexive TA.
Purpose
Analyses compared older drivers from urban, suburban, and rural areas on perceived importance of continuing to drive and potential impact that driving cessation would have on what they want and need to do.
Methods
The AAA LongROAD Study is a prospective study of driving behaviors, patterns, and outcomes of older adults. A cohort of 2,990 women and men 65‐79 years of age was recruited during 2015‐2017 from health systems or primary care practices near 5 study sites in different parts of the United States. Participants were classified as living in urban, surburban, or rural areas and were asked to rate the importance of driving and potential impact of driving cessation. Logistic regression models adjusted for sociodemographic and driving‐related characteristics.
Findings
The percentages of older drivers rating driving as “completely important” were 76.9%, 79.0%, and 83.8% for urban, suburban, and rural drivers, respectively (P = .009). The rural drivers were also most likely to indicate driving cessation would have a high impact on what they want or need to do (P < .001). After adjustment for sociodemographic and driving‐related characteristics, there was a 2‐fold difference for rural versus urban older drivers in odds that driving cessation would have a high impact on what they need to do (OR = 2.03; 95% CI: 1.60‐2.58).
Conclusions
Older drivers from rural areas were more likely to rate driving as highly important and the prospect of driving cessation as very impactful. Strategies to enhance both the ability to drive safely and the accessibility of alternative sources of transportation may be especially important for older rural adults.
Introduction:
Older adults are at a greater risk of injury and death in a motor-vehicle accident. While the ability to drive safely can be challenging with aging, the concept of self-regulation and associated support system have attracted more attention in recent years, especially in developed countries. This review describes the mechanism and summarizes the potential factors that influenced self-regulation of driving amongst older adults to provide new insights into a broader framework for transportation and safe mobility.
Methods:
We systematically searched 12 online databases for qualitative studies exploring the experiences of older adults aged 60 years and above on their decision to self-regulate their driving. Thematic synthesis was performed to identify elements influencing driving reduction and cessation. The confidence profile of each findings from the meta-synthesis was appraised using the Confidence in the Evidence from Reviews of Qualitative research (CERQual) tool.
Results:
A total of 17 studies representing views of 712 older adults from four countries were included. Three major themes were identified with each representing a transition phase that can either facilitate or hinder older drivers from ceasing completely or reducing their driving, when transitioning from pre-decision phase to post-cessation phase.
Conclusions:
Our findings suggest that there is a mismatch between the current traffic collation prevention measures, such as age-specific mandatory license renewal system and travel needs of older adults. As such, it is time for the authorities, researchers, and public from various fields and perspectives to collaborate, sustain, and improve safety and mobility in older adults. Practical applications: Adequate regulations and guidelines from the medical community and legal authorities are warranted to assist older adults and caregivers. Social support (e.g., feedback, assurance, or transportation support) from family members, friends, and healthcare professionals are crucial for a smooth transition. Provision of alternative transportations in rural areas are needed and future interventions should focus on engaging and educating older adults to consider alternative transportation modes for mobility. Age-specific mandatory license renewal procedure can be useful in screening for at-risk groups.
The purpose of this study on driving cessation was to explore the process of coping, decision-making and adaptation through this major life transition. We sought to examine understandings of the emotional responses of drivers and ex-drivers with dementia from the perspective of healthcare providers and family caregivers of persons with dementia. Interviews and focus groups were conducted with several key informant groups: healthcare providers who work with patients with dementia and their families (N = 10), representatives from organizations that provide services and support for persons with dementia (N = 6), and family caregivers of drivers and former drivers with dementia (N = 13). Data analysis involved inductive analytic techniques to generate descriptive and analytic themes from the data. The main themes from the analysis involve the: (1) Loss of independence and disruption to identity connected to emotional responses to driving cessation; (2) Experience of driving cessation as one loss within a series of losses related to dementia; (3) Importance of addressing emotional and identity-related effects in supportive responses to driving cessation; and (4) Support for maintained and adapted roles as a strategy to provide meaning and purpose in the context of driving cessation. Driving cessation can represent a significant disruption to identity, and is closely linked to losses, such as independence, within people’s broader experiences of grief and loss associated with dementia. The findings suggest the need for supportive responses that address unique emotion and identity-related aspects of driving cessation for people with dementia and their family caregivers.
Objective:
The aim of this project was to review the literature on interventions aimed at facilitating driving cessation in older adults, with and without dementia.
Methods:
A literature search was performed using the databases MEDLINE, CINAHL, Cochrane Central, Embase, and PsycINFO, from 1994 to September 2014. Two independent raters screened articles for inclusion and extracted study data. We only included articles if they directly addressed the topic of intervention approaches to facilitate the process of driving cessation in older adults or to support the adaptation of older adults who have had to stop driving and included a control group.
Results:
Of an initial 477 unique records identified, 111 pertained to driving cessation in older adults, and only three articles were controlled trials of intervention approaches related to driving cessation. One article described an intervention for retired drivers with dementia, while another was aimed at caregivers of drivers with dementia, and the third included retired and retiring drivers without dementia. Outcomes such as reduced depressive symptoms, increased trips out of home, and efficacy in dealing with the driving cessation process were positive, but the specific outcome measures and magnitude of effects varied across studies.
Conclusions:
Although the results summarized in this review point toward potentially promising effects of interventions for facilitating driving cessation in older adults, these findings must be interpreted with caution given the significant methodological limitations of the studies, including small samples, participant attrition, lack of blinding, and non-validated outcome measures. Copyright © 2017 John Wiley & Sons, Ltd.
Anticipated driving cessation required due to health or cognitive decline often evokes concerns about practical aspects of retaining mobility and quality of life as well as personal and social identity changes in older persons. While driving cessation is often perceived as stressful because it disrupts peoples' lives and poses practical hurdles, we argue that part of the stress associated with driving cessation can be attributed to identity change with regard to thinking of oneself as ‘no longer a driver’ as well as the perception of ‘getting old’. In an exploratory study, 208 older adults who had either ceased driving or had a plan to stop driving in the near future completed a ‘Driver Identity Survey’ with multiple questions about how they thought they would feel before and after stopping driving, as well as worries about practical hassles, life changes and changed relationships. Participants reported driving cessation as a significant life event associated with subjectively feeling older. Irrespective of current driving status, older participants identified the state of having ceased driving as associated with feeling older than their chronological age. Participants' expectations about practicalities and social identity changes were both significant predictors of stress associated with driving cessation. Discussion focuses on how expectations of anticipated changes in functionality and identity may influence driving cessation decisions and adjustment in later life.
Background:
Driver confidence can be measured through concepts such as driving frequency, situational avoidance, and self-perceptions. However, it is not clear how well confidence aligns with actual driving performance.
Purpose:
We examined the relationship between subjective measures of confidence in driving ability and on-road performance.
Method:
We report findings from two studies. The first compared scores from the Older and Wiser Driver Questionnaire to an on-road driving evaluation. The second looked at the Day and Night Driving Comfort Scales and Driving Habits and Intentions Questionnaire in relation to an on-road driving evaluation.
Findings:
No measures of confidence in driving ability were related to on-road driving performance.
Implications:
Confidence in driving ability bears little relationship to on-road performance. Future research should examine approaches to foster a better match between self-assessments and actual abilities among drivers.
The purpose of this study was to examine the trajectories of life-space before and after the transition to driving cessation among a diverse sample of community-dwelling older adults. Life-space scores and self-reported driving cessation were assessed at annual visits from baseline through Year 6 among participants in the University of Alabama at Birmingham Study of Aging. Approximately 58% of older adults reported having stopped driving during the 6 years of follow-up. After adjusting for potential confounders, results from a random intercept model indicate that mean life-space scores decreased about 1 to 2 points every year (p = .0011) and approximately 28 points at the time of driving cessation (p < .0001). The rate of life-space decline post driving cessation was not significantly different from the rate of decline prior to driving cessation. Driving cessation was associated with a precipitous decline in life-space score; however, the driving cessation event did not accelerate the rate of life-space decline.
Students in an undergraduate applied research in aging class learned about qualitative research methods by analyzing previously collected narratives. The interviews were with 32 subjects who were national experts in senior transportation in the United States. The purpose of the study was to explore the specialized supportive mobility needs of community-residing older adults. The policy goal of the study was to expand the discussion on levels of assistance needed in senior transportation. The educational goal of the study was to expose undergraduate students to qualitative research methods, having them analyze transcripts and audio recordings. In preparation for the research, students reviewed the current literature in transportation and aging and learned that the ability to get to where you want to go, when you want to go there is a key factor for aging-in-place in our communities. When that ability is compromised, the informal network of family and friends may not be a sustainable transportation option. Students were divided into three analysis groups by the domains of challenges, strategies, and policies and coded themes and subthemes through an iterative process. An important subtheme that emerged was the connection of community mobility to health care outcomes.
Self-regulation is a coping strategy that allows older drivers to drive safely for longer. Self-regulation depends largely on the ability of drivers to evaluate their own driving. Therefore the success of self-regulation, in terms of driving safety, is influenced by the ability of older drivers to have insight into their declining driving performance. In addition, previous studies suggest that providing feedback to older adults regarding their driving skills may lead them to change their driving behaviour. However, little is currently known about the impact of feedback on older drivers’ self-awareness and their subsequent driving regulatory behaviour. This study explored the process of self-regulation and driving cessation among older drivers using the PAPM as a framework. It also investigated older adults’ perceptions and opinions about receiving feedback in regards to their driving abilities. Qualitative focus groups with 27 participants aged 70 years or more were conducted. Thematic analysis resulted in the development of five main themes; the meaning of driving, changes in driving pattern, feedback, the planning process, and solutions. The analysis also resulted in an initial model of driving self-regulation among older drivers that is informed by the current research and the Precaution Adoption Process Model as the theoretical framework. It identifies a number of social, personal, and environmental factors that can either facilitate or hinder people’s transition between stages of change. The findings from this study suggest that further elaboration of the PAPM is needed to take into account the role of insight and feedback on the process of self-regulation among older drivers.
This special issue of the American Journal of Occupational Therapy includes summaries from a systematic evidence-based literature review of occupational therapy and driving and community mobility for older adults. Since the previous review on this topic in 2008, the cohort of 78 million baby boomers began turning 65 in January 2011. As a group, this cohort is more likely to have longer life expectancy, stay in the workforce longer, and age in place in the community. Is the occupational therapy profession ready for the potential demand for driving rehabilitation services from this generation of older drivers who grew up with the automobile and are dependent on it for access to and participation in their communities?
It is clear that while transition from being a driver to being a non-driver is an important, and often negative, event in the life of older adults, there is little support available to help older adults through this transition. This study focuses on increasing our understanding of issues about driving cessation and to inform the development of educational programs to assist older adults in positively adapting to retirement from driving. A total of 201 adults over age 70 with a valid driving license completed a mailed survey containing both open and closed-ended questions. Of the 96% of participants who were current drivers, 73.4% had never considered retiring from driving. While 70.6% of participants indicated that an educational program could help people plan to retire from driving, 55.8% indicated the possibility that they would participate in such a program. Participants provided insights into the format and content of educational programs to help older adults retire from driving including coping after retirement from driving, alternative forms of transportation and how to access them, and helping to decide when to retire from driving. It is imperative for practitioners to identify ways to help older adults who are resistant to planning for retirement from driving.
Introduction
Many older adults voluntarily restrict their driving or stop driving of their own accord. Driving behavior change may occur in stages, as predicted by the Transtheoretical Model of Behavior Change (TM).
Method
This study explored the process of older driver behavior change within the TM framework using interviews/focus groups with drivers and former drivers aged 71–94 years. Within those groups of drivers, driving behavior was divided into two classes: those who changed their driving with age and those who did not. Those who changed their driving as they aged included people gradually imposing restrictions (“gradual restrictors”) and those making plans in anticipation of stopping driving (“preparers”). Participants who did not change their driving included those who employed lifelong driving restrictions (“consistent”) and those who made no changes (“non-changers”).
Results
Preliminary support for TM within the driving context was found; however, further exploration of driving behavior change within this framework is warranted.
Practical applications
It is important to continue to investigate the factors that might influence driving behavior in older adults. By promoting self-regulation in individuals, it may be possible to help older adults continue to drive, thereby improving older adult's mobility and quality of life.
Older people today are more active and more mobile than previous generations. However, they continue to suffer a reduction in quality of life when giving up driving. This article reports research carried out to identify the role of mobility and accessibility in older people's self-reported quality of life, through an in-depth examination of older people's travel needs. A wholly qualitative approach, utilising a variety of data collection methods including focus groups, interviews and diary completion, was employed with 57 people aged over 65 in the UK, of which 26 were drivers and 31 had recently given up driving. The findings emphasise the importance of mobility for accessing services and shops. However, the reasons why older people travel and the importance of mobility go beyond accessibility to include the desire for independence, control, maintaining status, inclusion, ‘normalness’ and travel for its own sake. All these are related to an individual's perception of quality of life. When older people give up driving, their self-reported quality of life is reduced and this seems very much related to a reduction in affective and aesthetic qualities of mobility that a car affords that walking and using public transport lack. It is suggested that policy and practice needs to consider such motives for travel.
Relinquishing the privilege to drive is a difficult issue for older adults. To better understand factors that influence driving decisions and to identify approaches that could help ease the transition to a non-driving status, we conducted focus groups with elders who had recently stopped driving. Results demonstrate that the decision to stop driving is reluctantly made by elders on their own or after prompting from others. While all have other means of transportation, a sense of loss of independence remains. Participants urged policy makers to address older driver issues and were proponents of developing procedures to identify at-risk drivers. They also stressed the importance of making plans for retirement from driving. Findings suggest that while there is “life after driving,” efforts are needed to help older drivers, and their families develop a plan for driving cessation that includes identifying the appropriate time to stop and acceptable transportation alternatives to driving.
The Candrive II/Ozcandrive study, a multicentre prospective cohort study examining the predictive validity of tools for assessing fitness to drive, aims to develop an in-office screening tool that will help clinicians identify older drivers who may be unsafe to drive. This paper describes the study protocol. We are following a cohort of drivers aged ≥70 years for up to 4 years. Starting in 2009, 928 participants have been recruited in seven cities in four Canadian provinces, as well as 302 participants in two sites in Melbourne, Australia and Wellington, New Zealand. Participants underwent a comprehensive assessment at baseline and repeat the assessment yearly thereafter, as well as a brief follow-up assessment at 4 and 8 months each year. A recording device is installed in participants' vehicles to assess driving patterns, and driving records are obtained from licensing authorities to determine the outcomes: at-fault crashes per kilometre driven and violations. To date, the protocol has been generally well adhered to, with 1230 participants, and barriers and challenges are being addressed, as necessary. The Candrive II/Ozcandrive study is unique owing to its size, duration, partnerships with Canadian, Australian and New Zealand stakeholders, and international research collaboration.
The most common criteria recommended by philosophers of science for evaluating theories were organised within a hierarchy ranging from the least to the most risky tests for theories of health behavior change. The hierarchy progressed across: (1) Clarity; (2) Consistency; (3) Parsimony; (4) Testable; (5) Predictive Power; (6) Explanatory Power; (7) Productivity; (8) Generalisable; (9) Integration; (10) Utility; (11) Efficacy; and (12) Impact. The hierarchy was applied to the Transtheoretical Model (TTM) as an example of a health behavior change theory. The application was from the perspective of critics and advocates of TTM. Examples of basic and applied research challenging and supporting TTM across the hierarchy of criteria are presented. The goal is to provide a model for comparing alternative theories and to evaluate progress across the hierarchy within a particular theory. As theories meet criteria at each step in the hierarchy, the research and applications they generate can have increasing impacts on the science and practice of health behavior change.
Objectives:
To understand why older drivers living in a community setting stop driving.
Design:
A cross-sectional study within a longitudinal cohort.
Setting:
A geographically defined community in southern California.
Participants:
1,950 respondents age 55 and older who reported ever being licensed drivers.
Measurements:
A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information.
Results:
Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P < or = .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P < or = .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation.
Conclusion:
The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.
The purpose of this translational research article is to illustrate how general practice occupational therapists have the skills and knowledge to address driving as a valued occupation using an algorithm based on the Occupational Therapy Practice Framework: Domain and Process (2nd ed.; American Occupational Therapy Association, 2008b). Evidence to support the model is offered by a research study. Participants were compared on their performance of complex instrumental activities of daily living (IADLs) and a behind-the-wheel driving assessment. A significant relationship was found between the process skills from the performance assessment and whether the driver passed, failed, or needed restrictions as indicated by the behind-the-wheel assessment. The evidence suggests that occupational therapists using observational performance evaluation of IADLs can assist in determining who might be an at-risk driver. The algorithm addresses how driver rehabilitation specialists can be used most effectively and efficiently with general practice occupational therapy practitioners meeting the needs of senior drivers.
This manuscript addresses the following questions for licensing authorities: 1) Are drivers with Alzheimer's disease (AD) an issue that should concern licensing authorities? 2) What critical driving skills impacted by AD should authorities recognize? 3) What should their response be? 4) Do licensing authorities have a role in providing information about or referral to community agencies that offer alternative transportation options and other services?
To address issues important to licensing authorities the authors reviewed pertinent driving and dementia literature.
Drivers with AD have unique impairments that should be recognized and responded to early on in the disease process, with sensitivity and respect for continued mobility. As the disease progresses and they must stop driving, former drivers and their families could benefit from resource referrals that provide information about transportation alternatives and support services in their communities.
The authors believe that drivers with AD should be a concern for licensing authorities. Licensing decisions and policies to assess and regulate drivers are in the end made individually by each state. Policymakers will make their decisions based upon current research and concerns of their constituency and need to consider a seamless approach to addressing safe mobility. Licensing authorities are an important partner along with individuals, family members, health care professionals, social service providers, researchers, and policymakers in assuring public safety and individual mobility. All of the partners should confront the concern directly-none should "look the other way." The goal is to keep people driving safely for as long as possible. The responsibility is to recognize, respond, and refer when driving safely is no longer assured.
We estimated total life expectancy and driving life expectancy of US drivers aged 70 years and older.
Life table methods were applied to 4699 elderly persons who were driving in 1993 and reassessed in a 1995 survey.
Drivers aged 70 to 74 years had a driving life expectancy of approximately 11 years. A higher risk of mortality among men as a cause of driving cessation offset a higher risk of driving cessation not related to mortality among women that resulted in similar driving life expectancies.
Nationwide, many elderly drivers quit driving each year and must seek alternative sources of transportation. Because of differences in life expectancy, women require more years of support for transportation, on average, than men after age 70.
To determine off-road and on-road driving evaluation practices of clinicians in the United States and Canada who assess individuals with disabilities for fitness to drive.
Participants were 114 clinician attendees at the 2003 annual Association of Driver Educators for the Disabled with driving assessment experience ranging from 1 month to 25 years.
Information was elicited regarding the clinician, clientele, referral practices, and off-road and on-road driving evaluation practices and retraining practices using a self-administered questionnaire.
Participants were largely occupational therapists (68%) who worked in 42 different states and provinces. The most prevalent clientele were persons with traumatic brain injury (97%) and stroke (96%). Testing times greater than 60 min were common for both the off-road (61%) and on-road (49%) evaluations. Commonly performed off-road assessments included the Brake Reaction Timer; Trail Making Test, Parts A and B; and the Motor Free Visual Perception Test, used by 73%, 72%, and 66%, respectively; comprehensive computer-based driving evaluation was rare. Sixty-one percent indicated that all clients underwent on-road evaluation regardless of the off-road results. Finally, 78% used a standard driving route, whereas 24% used a scoring system to evaluate on-road driving.
Driving assessment in Canada and the United States is multidimensional and time-intensive. Although the domains being assessed are similar across clincians, specific off-road and on-road assessment practices vary greatly. The majority use nonstandardized on-road assessments.
Surface Transportation Policy Project
- L Bailey
Aging Americans: Stranded without options . Surface Transportation Policy Project
- L Bailey
Bailey, L. (2004). Aging Americans: Stranded without options. Surface Transportation Policy
Project. https://www.apta.com/wp-content/uploads/Resources/resources/reportsandpublications/Documents/aging_stranded.pdf
Metasynthesis of patient preferences for communication with health care providers
- M E Betz
- K Scott
- J Jones
- C Diguiseppi
Betz, M. E., Scott, K., Jones, J., & Diguiseppi, C. (2016). "Are you still driving?"
Metasynthesis of patient preferences for communication with health care providers.
Traffic Injury Prevention, 17(4), 367-373. https://doi.org/10.1080/15389588.2015.
1101078
Looking forward and looking back: Older adults' views of the impacts of stopping driving. Occupational Therapy in Health Care
- N W Mullen
- B Parker
- E Wiersma
- A Stinchcombe
- M Bédard
Mullen, N. W., Parker, B., Wiersma, E., Stinchcombe, A., & Bédard, M. (2017). Looking
forward and looking back: Older adults' views of the impacts of stopping driving.
Occupational Therapy in Health Care, 31(3), 188-204. https://doi.org/10.1080/07380577.
2017.1337282
Planning for the road ahead
- A E Dickerson